Healthcare Provider Details

I. General information

NPI: 1316977028
Provider Name (Legal Business Name): DAVID R POWERS MD APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 CHEROKEE ROSE LANE
COVINGTON LA
70433
US

IV. Provider business mailing address

217 CHEROKEE ROSE LANE
COVINGTON LA
70433
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-0911
  • Fax: 985-875-7565
Mailing address:
  • Phone: 985-893-0911
  • Fax: 985-875-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number207RN0300X
License Number StateLA

VIII. Authorized Official

Name: DAVID R POWERS
Title or Position: CHEIF EXECUTIVE OFFICER
Credential: M.D.
Phone: 985-893-0911